In 1984 doctors told Patricia Paul, who suffers from a painful nerve condition called reflex sympathetic dystrophy, that she would need round-the-clock home care for the rest of her life and that she should forget about working ever again. Since then, she has returned to college, graduated magna cum laude, reared a teen-aged son and now runs an award-winning job-training program for handicapped people in New Jersey.
She attributes her remarkable turnaround to medical treatment that would have been unthinkable a decade ago: At her doctor's suggestion, she has taken large doses of narcotics, in pill form, every three hours for the last nine years.
"I used to sit in a wheelchair doing nothing," Ms. Paul, 47, said in a recent interview from her office at the Association for Retarded Citizens in Elmwood Park, N.J. "That medicine has given me the ability to live again."
Long considered hopelessly mind-numbing and addictive, and suitable only for the dying, narcotics are being prescribed with growing frequency by pain specialists who have made the surprising discovery that people who take them can lead normal lives.
Doctors who specialize in pain treatment say that unlike street addicts who experience euphoria from drugs like heroin, pain patients get no high from their pills -- they just get pain relief. More important, they say that patients on daily stable doses of the drug quickly adapt to the lethargy these drugs normally produce, so that in a week they are able to work and even drive a car.
And so, more and more patients are being prescribed narcotics like morphine, methadone and Dilaudid as a therapy of last resort to treat chronic intractable pain. Scorn and Discrimination
"There is a growing literature showing that these drugs can be used for a long time, with few side effects and that addiction and abuse are not a problem," said Dr. Russell Portenoy, a pain specialist at the Memorial Sloan- Kettering Cancer Center in New York.
Dr. Portenoy and others say the worst side effect may be the scorn and discrimination that some patients suffer from their families, employers and even the medical world.
Mrs. Paul said she decided not to seek custody of her children during her divorce several years ago because her husband had threatened to bring up her drug use in court. When she developed a life-threatening blood clot in her lung while her doctor was on vacation, she at first refused to go to the hospital, afraid to tell another doctor about the drugs she must take; her friends took her in, nearly comatose.
Until now she has lived, as she puts it, "in the closet," going to extremes to hide her medical needs. "I hold a responsible job and I'm respected in the community and I'm sure I would lose all that if anyone knew," she said before deciding to speak openly with a reporter. "I want to dispel biases but I'm afraid of recriminations. Imagine being a diabetic and being afraid to let anybody know."
Dr. Marcus Reidenberg, professor of clinical pharmacology at New York Hospital-Cornell Medical Center, said: "You can't tell these people are on narcotics, because their behavior is normal. But -- it's so unfair -- they meet with disapproval from within the medical profession and without." Fear of Creating Addicts
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